Definition

Encephalopathy is a term used to describe a condition that affects the function or structure of the brain, resulting in damage or dysfunction. It encompasses a group of disorders with various causes. There are many types of encephalopathy, some are permanent while others are transient. Some are present from birth and remain unchanged, while others are acquired after birth and worsen over time. Symptoms also vary, ranging from memory impairment or personality changes to severe symptoms such as seizures, coma, or even death.

Here are some types of encephalopathy along with their causes:

Chronic traumatic encephalopathy

This type of encephalopathy occurs when there is repeated trauma or injury to the brain over a prolonged period. These head injuries cause nerve damage in the brain. It is usually found in boxers, football players, or military personnel injured due to explosions.

Glycine encephalopathy

Glycine encephalopathy is a genetic or inherited condition where there is a very high level of glycine (an amino acid) in the brain. Symptoms of glycine encephalopathy usually appear in infants shortly after birth.

Hashimoto's encephalopathy

This is a rare type of encephalopathy associated with the autoimmune condition Hashimoto's thyroiditis. In Hashimoto's thyroiditis, the immune system mistakenly attacks the thyroid gland responsible for producing many important hormones in the body. However, it is not yet known exactly how Hashimoto's thyroiditis can cause encephalopathy.

Hepatic encephalopathy

Hepatic encephalopathy is a brain disorder caused by liver disease. When the liver does not function properly, toxins that are normally removed by the liver accumulate in the blood and can eventually reach the brain.

Hypertensive encephalopathy

Hypertensive encephalopathy is a complication of very high and uncontrolled blood pressure. This occurs if hypertension is not regularly treated. High blood pressure can cause swelling and damage to the brain.

Hypoxic-Ischemic encephalopathy

This condition is a type of brain damage that occurs when the brain does not receive enough oxygen. This can cause permanent brain damage or dysfunction. For example, in babies exposed to alcohol in utero, alcohol can cause brain disturbances during development.

Toxic-Metabolic encephalopathy

Toxic-metabolic encephalopathy results from infection, toxins, or organ failure. When electrolytes, hormones, or other chemicals in the body are out of balance, they can affect brain function. This condition can also be caused by infections or the presence of toxic chemicals in the body. Encephalopathy usually resolves when the imbalance, infection, or toxins causing brain disorders are eliminated.

Infectious encephalopathy

One example is transmissible spongiform encephalopathy, also known as prion disease. Prions are proteins that occur naturally in the body but can mutate and cause diseases that gradually damage and worsen the brain (neurodegenerative diseases).

Uremic encephalopathy

Uremic encephalopathy is a complication of kidney failure. Kidney failure causes the accumulation of uremic toxins in the blood which, if they reach the brain, will affect brain function. This condition can cause mild confusion to deep coma.

Wernicke's encephalopathy

Also known as Wernicke's disease. This condition is caused by a deficiency of vitamin B1. Long-term alcoholism, poor nutrition, and poor food absorption can lead to a lack of vitamin B1. If Wernicke's encephalopathy is not promptly treated, it can lead to the more severe Wernicke-Korsakoff syndrome.

Risk factor

Here are some factors that can increase the risk of encephalopathy:

• Excessive and long-term alcohol consumption, which can increase the risk of liver disorders and hepatic encephalopathy.
• Military personnel and athletes, such as boxers or football players, who experience repeated head injuries are at risk of developing chronic traumatic encephalopathy.
• Uncontrolled hypertension, which can lead to hypertensive encephalopathy complications.
• Vitamin B1 deficiency, which can lead to Wernicke's encephalopathy.
• Having a family member with a history of encephalopathy.

Symptoms

Symptoms depend on the cause and severity of encephalopathy. Symptoms can affect changes in mental and neurological conditions or nerve function. Some mental changes that may occur include:

• Memory impairment
• Difficulty concentrating and focusing
• Problem-solving skills disorder
• Personality changes (e.g., becoming more open or more reserved)
• Lethargy and drowsiness

Neurological disorders that may be experienced include:

• Muscle weakness in one area
• Unintended twitching
• Tremor or shaking
• Difficulty speaking or swallowing
• Seizures

Diagnosis

To diagnose encephalopathy, the doctor will inquire about your medical history and symptoms. The doctor will also perform a physical examination to check mental and neurological conditions. If the doctor suspects you have a brain disease, they will perform tests to determine the cause and severity of the disease. These tests include:

• Blood tests to detect bacterial or viral infections, toxin exposure, hormonal imbalances, chemicals in the body, or the presence of prions.
• Lumbar puncture to take a sample of spinal fluid to search for the cause of the disease (bacteria, viruses, toxins, or prions).
• Brain CT or MRI to detect abnormalities or damage to the brain.
• Electroencephalogram (EEG) to measure electrical activity in the brain.

Management

Encephalopathy therapy varies depending on the cause. Treatment can include medications to manage symptoms and treat the underlying cause, or surgical procedures if necessary.

The doctor may recommend nutritional supplements to slow brain damage or a special diet to treat the underlying cause of encephalopathy. In some cases, such as when the brain does not receive enough oxygen, the patient can fall into a coma. In severe cases like this, the doctor will provide intensive care using life-support tools.

The patient's long-term condition depends on the cause and severity of encephalopathy. Many types of encephalopathy are reversible or can recover if the cause is treated. However, all types can be fatal if the condition is too severe, especially if diagnosed late.

According to the National Institute of Neurological Disorders and Stroke, transmissible spongiform encephalopathy usually causes death within three months to several years after the onset of the disease. Treating the underlying cause of encephalopathy can improve symptoms or even cure encephalopathy.

Good cooperation between healthcare workers and the patient's family in carrying out care and a continuous therapy plan can support the patient's life if brain damage occurs.

Complications

Encephalopathy complications vary from no complications at all to severe mental disorders that can cause death. Complications depend on the primary cause, such as the following examples:

• Hepatic encephalopathy: Brain swelling with herniation (shifting part of the brain), coma, or death.
• Metabolic encephalopathy: Irritability, lethargy, depression, tremor, coma, or death.
• Hypoxic encephalopathy: Ranges from no complications in short-term hypoxia to personality changes, severe brain damage, or death in long-term hypoxia.
• Uremic encephalopathy: Lethargy, hallucinations, stupor, muscle twitching, seizures, or death.
• Hashimoto's encephalopathy: Confusion, heat intolerance, dementia.
• Wernicke's encephalopathy: Confusion, memory loss, decreased ability to move the eyes.
• Bovine spongiform encephalopathy (mad cow disease): Ataxia, dementia, and myoclonus (irregular muscle twitching).
• Shigella encephalopathy: Headache, stiff neck, delirium, seizures, coma.
• Infectious encephalopathy in children: Fussiness, poor eating, hypotonia (floppy baby syndrome), seizures, or death.

Prevention

Some types of encephalopathy, including hereditary ones, cannot be prevented. However, other types of encephalopathy can be prevented by controlling or avoiding risk factors. The following steps will reduce your risk of encephalopathy:

• Avoiding alcohol and narcotic drugs
• Avoiding exposure to toxic substances
• Eating healthy and nutritious food
• Regular health check-ups
• Adopting a healthy lifestyle

When to see a doctor?

You should immediately see a doctor if you experience encephalopathy symptoms. If you are already receiving treatment, be alert to the following emergency signs:

• Severe confusion
• Severe disorientation
• Coma

These signs indicate a worsening condition. If you or someone around you experiences these symptoms, seek medical help immediately to prevent the condition from worsening.

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